Police-reported family violence victimisation or perpetration and mental health-related emergency department presentations: an Australian data-linkage study.

BACKGROUND: Family violence is a leading social determinant of mental ill-health but its link to mental health-related emergency department presentations is poorly understood. Existing research has largely used retrospective designs with a focus on victimisation, typically among women. We examined whether police-reported family violence victimisation and perpetration were prospectively associated with mental health emergency department presentations in women and men. We also identified family violence risk and vulnerability characteristics associated with such presentations. METHODS: Demographics, prior police involvement, and individual and relationship vulnerabilities were provided by Victoria Police for 1520 affected family members (i.e., primary victims) and 1470 respondents (i.e., persons alleged to have perpetrated family violence) from family violence reports in 2016-17. Emergency mental health presentations 22-30 months post-family-violence report were determined through linkage with the Victorian Emergency Minimum Dataset and compared to statewide presentations. RESULTS: Emergency mental health presentations during follow-up were identified in 14.3% of the family violence sample, with 1.9% presenting for self-harm. Mental health presentation rates per 1,000 people were markedly higher among affected family members and respondents of both sexes and all ages than in the general population, except for male affected family members aged 45 + . Adjusting for age and sex, the mental health presentation rate was 6 and 11 times higher among affected family members and respondents, respectively, than in the general population. Individual vulnerabilities were more closely related to risk of emergency mental health presentations than relationship characteristics. CONCLUSIONS: Police-recorded family violence is associated with increased mental health-related emergency department presentations over the short-to-medium term. Strengthened cross-sector collaboration is needed to identify, address, and refer individuals with overlapping family violence and mental health needs and to improve victims' and perpetrators' access to community mental health and related services. This should help prevent individuals from reaching a crisis point in their mental health.

The Role of Situational Factors in Child-to-Parent Abuse: Implications for Assessment, Management, and Intervention.

Situational factors are relevant to the initiation and maintenance of violent behavior yet are infrequently examined in relation to family violence. Content analysis was used to conduct an inductive thematic analysis of police narratives to identify and quantify the occurrence of situational factors among Australian young people (10-24 years) reported to police for using violence toward a parent (n = 82). Descriptive information about demographics (e.g., age and sex), background characteristics (e.g., victimization history, employment/school issues, mental health issues, and neurodevelopmental conditions), and features of the index incident (e.g., type of aggression) were also extracted from police records. Interpersonal conflict and parental limit-setting were the most common situational antecedents of child-to-parent abuse, with additional situational factors including use of weapons, role of third parties, mental health concerns, and substance abuse issues. Families experiencing child-to-parent abuse showed heightened levels of intrafamilial violence and neurodevelopmental conditions. Implications for risk assessment, management, and intervention are discussed.

Using the Dynamic Appraisal of Situational Aggression (DASA) to assess the impact of unit atmosphere on violence risk assessment.

WHAT IS KNOWN ON THE SUBJECT: Research suggests that the Dynamic Appraisal of Situational Aggression (DASA) is a useful risk assessment instrument to identify individuals who might be at risk of aggression in mental health inpatient units. Although, risk assessment research has typically focused on an individual's risk of aggression, recent research has begun exploring whether the DASA could be used to assess the likelihood that a group of patients would be aggressive. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: While the DASA was useful for assessing whether an individual was likely to be aggressive, the group average score was not a useful indicator for the likelihood of aggression once the individual DASA score was taken into consideration. Unexpectedly, patients who were assessed as high risk on the DASA were more likely to be aggressive on settled units compared to unsettled units, which included other individuals whose risk was elevated. WHAT ARE THE IMPLICATIONS FOR PRACTICE: There is not enough evidence to suggest that the group DASA average improves the identification of aggression above the individual DASA score. ABSTRACT: INTRODUCTION: The Dynamic Appraisal of Situational Aggression (DASA) is an inpatient aggression risk assessment instrument. Recently, research explored whether the unit atmosphere, as indicated by a unit's average DASA score, was related to inpatient aggression risk, but failed to control for individual risk. AIM: Investigate whether the DASA unit average score or an interaction between the unit average and an individual patient's DASA score was related to the likelihood that an individual would act aggressively. METHOD: Cox regression with repeated assessments and recurrent events was used to analyse 11,243 DASA risk assessments of 113 inpatients collected via retrospective file review. RESULTS: The unit DASA average score was not related to aggression towards staff. There was a negative interaction between the individual and the unit DASA average scores when identifying patient-to-patient aggression; high-risk patients engaged in less aggression when the unit average was heightened relative to units with lower DASA average scores. DISCUSSION: It is possible that there were more nursing interventions and/or patients engaged in greater self-regulation on unsettled units, thus reducing aggression. IMPLICATIONS FOR PRACTICE: Currently, there is insufficient evidence to suggest that the unit average score should be used to supplement individual DASA scores to identify aggression risk.

Investigating the dynamic nature of multiple risk assessment instruments in a forensic mental health hospital.

Readministration of multiple risk assessment instruments to determine the risk of aggression over the short, medium, and long term is common practice in many forensic mental health settings. Justification for the repeated administration and use of multiple instruments is based on purported differences in discriminative validity of risk factors according to whether they are characterized as static, stable, or acute, and the composition of these tools, in terms of the relative balance of different types of risk factors, which can impact the discriminative validity of these instruments over different follow-up periods. However, research has yet to determine whether the use of multiple and repeated administration of risk assessment instruments improves identification of risk, and it may be the case that the heavy burden on service providers to administer multiple instruments is unwarranted. In this study, time-dependent cox regression with repeated assessments and recurrent events was used to investigate the dynamic nature and incremental validity of the dynamic appraisal of situational aggression (DASA), short-term assessment of risk and treatability (START), and HCR-20v3, which were repeatedly rated on a sample of forensic mental health inpatients (N = 240) over a 2-year period. Results suggest that using the rolling mean or the most recent risk assessment yielded the most accurate characterization of change in aggression risk. Repeated administration of dynamic risk instrument instruments improved the identification of aggression beyond the initial risk assessment. Although static, stable, and acute factors were significantly related to aggression, the combination of data from multiple risk assessment instruments may not result in clinically meaningful improvements in risk identification. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Social-Cognitive Investigation of Young Adults Who Abuse Their Parents.

Within the past decade, there has been an increase in research focusing on young people who abuse their parents. However, most research has narrowly focused on adolescent children, neglecting to investigate the nature, pattern, and factors related to child-to-parent abuse perpetrated by young adults. This article integrated two complementary social-cognitive theories of aggression to explore factors associated with perpetration of child-to-parent abuse among university students (N = 435, aged 18-25 years). Participants completed the Abusive Behavior by Children-Indices, a self-report measure that was designed to differentiate abusive and normative child-to-parent behavior. The results highlight that abuse is not limited to adolescent children, as one in seven young adults were categorized as abusive toward a parent over the previous 12 months. Sons were more likely than daughters to report abusing their parents. Specifically, sons disclosed greater rates of father abuse than daughters, but similar rates of mother abuse. Hierarchical logistic regression found that exposure to marital violence, parent-to-child aggression, trait anger, and aggressive scripts were significant predictors of both mother and father abuse. However, other factors related to abuse differed according to which parent was the target of abuse. For instance, male sex was a significant predictor of father abuse, whereas rumination and impulsive emotional regulation were significant predictors of mother abuse. Overall, father abuse was better explained by the model than mother abuse. The results suggest that although factors related to general aggressive behavior may be good predictors for father abuse, additional factors may be needed to explain mother abuse.

On the modulation and maintenance of hibernation in captive dwarf lemurs.

In nature, photoperiod signals environmental seasonality and is a strong selective "zeitgeber" that synchronizes biological rhythms. For animals facing seasonal environmental challenges and energetic bottlenecks, daily torpor and hibernation are two metabolic strategies that can save energy. In the wild, the dwarf lemurs of Madagascar are obligate hibernators, hibernating between 3 and 7 months a year. In captivity, however, dwarf lemurs generally express torpor for periods far shorter than the hibernation season in Madagascar. We investigated whether fat-tailed dwarf lemurs (Cheirogaleus medius) housed at the Duke Lemur Center (DLC) could hibernate, by subjecting 8 individuals to husbandry conditions more in accord with those in Madagascar, including alternating photoperiods, low ambient temperatures, and food restriction. All dwarf lemurs displayed daily and multiday torpor bouts, including bouts lasting ~ 11 days. Ambient temperature was the greatest predictor of torpor bout duration, and food ingestion and night length also played a role. Unlike their wild counterparts, who rarely leave their hibernacula and do not feed during hibernation, DLC dwarf lemurs sporadically moved and ate. While demonstrating that captive dwarf lemurs are physiologically capable of hibernation, we argue that facilitating their hibernation serves both husbandry and research goals: first, it enables lemurs to express the biphasic phenotypes (fattening and fat depletion) that are characteristic of their wild conspecifics; second, by "renaturalizing" dwarf lemurs in captivity, they will emerge a better model for understanding both metabolic extremes in primates generally and metabolic disorders in humans specifically.

Measuring stalking: the development and evaluation of the Stalking Assessment Indices (SAI).

Accurate measurement of stalking has proven difficult, partly because stalking is characterised by the cumulative effects of a pattern of behaviour. This study aimed to develop and evaluate a new measure of stalking that overcomes the observed shortcomings of existing tools. The Stalking Assessment Indices (SAI) were created using index development principles and evaluated in 244 Australian undergraduate students (M age= 33.7, 77% female). Seventy-three reported stalking victimisation (experiencing at least five intrusions over at least two weeks causing substantial fear or distress), and 51 reported stalking perpetration. Stalking behaviours reported by victims formed a two-component structure, which was also observed in multidimensional scaling analysis. The perpetration index showed good convergent validity with measures of rumination and aggression, and both indices had adequate test-retest reliability over four weeks. These results suggest that the SAI could provide a consistent and inclusive measure of stalking for use across different research settings.

Evaluating the legal assumptions of Victoria's Sex Offender Registration Act 2004 from a psychological perspective.

The Sex Offender Registration Act 2004 was introduced in Victoria to decrease recidivism and aid in future investigations and prosecutions. This article reviews literature to evaluate four assumptions inherent to the Act: (a) sexual offenders are more dangerous than non-sexual offenders; (b) sexual offenders who target children are more dangerous than those who target adults; (c) recidivism risk can be accurately assessed for sexual offenders who target adults; and (d) the Act is a useful tool for investigations and prosecutions. The findings suggest that there is little evidence that supports the assumptions. Further, given the relatively narrow scope of the Act, it is unlikely to have a positive impact on the safety of the community.

The Predictive Validity of the Static-99, Static-99R, and Static-2002/R: Which One to Use?

The use of Static tools (Static-99, Static-99R, Static-2002, and Static-2002R) in risk decision making involving sexual offenders is widespread internationally. This study compared the predictive accuracy and incremental validity of four Static risk measures in a sample of 621 Australian sexual offenders. Results indicated that approximately 45% of the sample recidivated (with 18.8% committing sexual offenses). All of the Static measures investigated yielded moderate predictive validity for sexual recidivism, which was comparable with other Australian and overseas studies. Area under the curve (AUC) values for the four measures across the 5-, 10-, and 15-year intervals ranged from .67 to .69. All of the Static measures discriminated quite well between low-risk and high-risk sexual offenders but less well for the moderate risk categories. When pitted together, none of the tools accounted for additional variance in sexual recidivism, above and beyond what the other measures accounted for. The overall results provide support for the use of Static measures as a component of risk assessment and decision making with Australian sexual offending populations. The limitations of this study and recommendations for further research are also discussed.

Co-occurring mental illness, substance use disorders, and antisocial personality disorder among clients of forensic mental health services.

OBJECTIVE: Despite the number of studies investigating co-occurring disorders, and more recently, co-occurring disorders and criminal offending, few studies have considered samples from forensic mental health services. The present study was conducted to investigate the relationship between mental illness, substance use disorders, antisocial personality disorder, and offending. METHOD: The prevalence of co-occurring disorders was investigated in 130 male offenders who had contact with the statewide forensic mental health service in Victoria, Australia. Offense histories and severity of offending were compared among participants diagnosed with a single mental illness (or no mental illness), co-occurring mental illness and substance use, and co-occurring disorders plus antisocial personality disorder. RESULTS: The majority of participants had co-occurring mental and substance use disorders; a significant minority met the criteria for antisocial personality disorder. Participants with co-occurring mental illness and substance use disorders, and those who had an additional diagnosis of antisocial personality disorder, were responsible for more serious and frequent offending than those with mental illness alone. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Forensic mental health services must take into account the effect that co-occurring disorders have on clients' functioning and offending. Those who work with people with psychiatric disabilities and co-occurring substance use disorders must ensure that the substance disorders are addressed to help ensure recovery from the mental illness and to reduce the likelihood of offending. (PsycINFO Database Record

Dysplasia in Barrett esophagus.

BACKGROUND: Dysplasia in Barrett esophagus is a premalignant condition that is associated with an increased risk of developing esophageal adenocarcinoma. Unfortunately, clinical investigation aimed at prevention of progression to malignant disease has been hampered by the variable prevalence of dysplasia reported in the literature. The objective of the current study was to more accurately determine the prevalence of dysplasia among individuals with Barrett esophagus who would be available for enrollment in a chemoprevention trial. METHODS: The pathology archives of 3 institutions were reviewed over a 5-year period for all reports of diagnoses of Barrett esophagus. Surgical cases, malignancies, and duplicate or referral cases were excluded from the analysis. RESULTS: A total of 790 cases of Barrett esophagus were identified. Of these, 37 (4.7%) were cases of low-grade dysplasia (LGD), and 20 (2.5%) were cases of high-grade dysplasia. The University of Michigan Medical Center (Ann Arbor, MI) diagnosed 18 cases of LGD, Henry Ford Hospital (Detroit, MI) diagnosed 15 cases of LGD, and Brigham and Women's Hospital (Boston, MA) diagnosed 4 cases of LGD in patients with Barrett esophagus over the 5-year study period. CONCLUSIONS: The confirmed low prevalence of cases of LGD will affect the design of future clinical trials of chemopreventive interventions for Barrett esophagus.

Intraprison HIV transmission: an assessment of whether it occurs, how it occurs, and who is at risk.

The prevalence of AIDS infection is approximately five times higher in state and federal prisons than among the general U.S. population. It is also apparent that high-risk HIV transmission behaviors occur inside prison; however, data validly documenting instances of intraprison HIV transmission are rare. This study validly identifies 33 inmates in a large sample of state prison inmates who contracted HIV inside prison and presents data on how they likely contracted HIV. It further compares these inmates to inmates who did not contract HIV inside prison in terms of age, race, and level of education. Documenting the burden posed by HIV transmission inside prison, providing insight into how they contract HIV inside prison, and what types of inmates are at risk will help public and correctional health officials reform their current education and prevention practices and ultimately reduce or prevent HIV transmission both inside and outside prison.